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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A case for early surgery in native left-sided endocarditis complicated by heart failure: Results in 203 patients
Journal of the American College of Cardiology, Volume 18, No. 3, Year 1991
Notification
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Description
From January 1982 to December 1988, 203 consecutive patients were selected for early valve replacement (mean 10 days from time of admission) if they had clinical evidence of native valve endocarditis with 1) vegetations on echocardiography, 2) severe valvular lesions, and 3) heart failure. Surgery was performed within 7 days of admission in 56% of patients and was done urgently because of hemodynamic deterioration in 108 (53%). All vegetations were identified by echocardiography and confirmed macroscopically at surgery. One hundred ten patients had isolated aortic valve infection, 50 had isolated mitral valve infection (p < 0.05 for aortic vs. mitral) and 43 had double-valve infection. Mean aortic cross-clamp time was 57, 38 and 67 min, respectively. Sixty-four patients (32%) had extensive infection involving the anulus or adjacent tissues, or both; such infection more frequently involved the aortic than the mitral valve (p < 0.05). Thirty-eight patients (35%) with aortic valve infection had abscess formation compared with 1 patient (2%) with mitral valve infection (p < 0.05). Only eight patients (4%) died in the hospital. There were seven patients (3%) with a periprosthetic leak and five patients (3%) with early prosthetic valve endocarditis. Long-term follow-up, available in 174 hospital survivors (89%), revealed 10 deaths and two new ring leaks at 38 ± 22 months. In conclusion, among patients with endocarditis who need surgery for heart failure, aortic valve infection is more prevalent than mitral valve infection and is more often associated with extensive infection, including abscess formation. However, even the presence of heart failure and extensive infection is not necessarily associated with high surgical risk when surgery is performed early. © 1991.
Authors & Co-Authors
Middlemost, Shirley J.
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Wisenbaugh, Thomas W.
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Meyerowitz, Colin
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Teeger, Susan
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Essop, Rafique M.
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Skoularigis, John S.
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Cronje, Stephanus L.
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Sareli, Pinhas E.
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Statistics
Citations: 133
Authors: 8
Affiliations: 1
Identifiers
Doi:
10.1016/0735-1097(91)90785-8
ISSN:
07351097
Research Areas
Health System And Policy
Study Design
Cohort Study